Broken nights are one of the most common parts of pregnancy, but poor sleep and mood are closely linked. Here is how to tell an ordinary run of bad nights from something more, and practical things that genuinely help.
It is three in the morning. You have been to the toilet twice, your hips ache whichever way you turn, and the baby has decided now is the time to practise kicking. You lie there doing sums about how many hours you have left before the alarm. Or perhaps your body is comfortable enough, but your mind will not switch off: the list of things to buy, the scan next week, whether you are ready for any of this.
If you can't sleep in pregnancy, you are far from alone. Broken nights are one of the most common things women tell their midwife about, and one of the things they are most likely to brush off as "just part of it".
Some of it is part of it. But sleep and mood are closely tied together, and it is worth knowing when a bad patch of nights is simply the body doing its work, and when it is telling you something more.
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Why sleep changes so much in pregnancy
Pregnancy changes almost everything that helps us sleep. In the early weeks, rising levels of the hormone progesterone can make you feel heavy with tiredness in the day and then oddly wakeful at night. Nausea does not always keep to the morning. You may need the toilet more often, even before your bump shows.
Later on, the physical side takes over. It gets harder to find a comfortable position. Heartburn, cramp in the legs, a blocked nose, back and pelvic pain and a busy baby all have a way of turning up at bedtime. Some women get restless legs, an uncomfortable, creeping urge to move the legs that is worst in the evening and eases when you get up and walk about.
Then there is the mind. Pregnancy is a time of big change, even when the baby is very much wanted. Night is when the day's noise falls away and the worries have room to speak. It is very common to wake in the small hours and find your thoughts racing about the birth, money, work, your relationship or the baby's health.
From around 28 weeks, your midwife will also advise you to go to sleep on your side rather than on your back. If you wake up on your back, that is fine: simply turn over. I mention it because some women become so anxious about getting this right that the worry itself keeps them awake. A pillow behind your back is usually all you need.
A run of bad nights, or something more?
This is the question that matters most, and it is not always easy to answer on your own when you are tired. Here is how I tend to think about it.
When it is most likely ordinary pregnancy tiredness
You wake in the night, but you can usually get back to sleep once you have been to the toilet or shifted position. You feel worn out, but you can still enjoy things: a meal out, a funny programme, seeing a friend. You may be more irritable than usual, but it passes. On a day when you manage a nap or a lie-in, you feel noticeably better. Your worries are real but you can put them down for a while.
When it may be becoming something more
Things are different when sleep problems and low mood or anxiety start to feed each other. Watch for these kinds of changes:
- You can't sleep even when you have the chance. Your partner takes over, the house is quiet, you are exhausted, and still you lie there wide awake.
- You wake very early and can't get back off, often with a heavy, dreading feeling about the day ahead.
- The worry has taken over. Your mind goes round and round the same fears, you can't distract yourself, and you may feel your heart racing or your chest tight in bed.
- The days are getting harder, not easier. It has gone on for more than two weeks and is getting worse rather than settling.
- The good bits have gone flat. Things you would normally enjoy, including thinking about the baby, feel like effort or leave you cold.
- Ordinary life is slipping. You are struggling to work, eat properly, look after yourself or face people.
- You feel bad about yourself. Thoughts like "I'm useless", "I can't cope" or "I'll be a terrible mother" are there most of the time.
Put simply: tiredness from pregnancy usually lifts, at least a little, when you rest. Anxiety and depression tend to steal the rest itself, and they colour how you feel about yourself and the future. If that sounds more like you, it is not a sign of weakness, and with the right help it can get better.
One more thing. If you have had depression, anxiety or bipolar disorder in the past, poor sleep in pregnancy can sometimes be one of the first signs that you are becoming unwell again. In that case I would rather you mentioned it early than waited to see.
Things that genuinely help
None of these will give you the sleep you had before pregnancy, and I would not want you to measure yourself against that. The aim is to make the nights a little kinder and to protect your mood while you wait for the baby.
1. Make your body comfortable first
Pillows are worth more than any gadget. One between your knees, one supporting your bump and one behind your back can make lying on your side much easier. If heartburn is keeping you up, eat your last proper meal a few hours before bed and raise the head end of the bed a little. For cramp and restless legs, gentle stretching of the calves before bed often helps. Do tell your midwife about restless legs, as a simple blood test can check whether you are low in iron.
2. Get daylight and gentle movement in the day
A walk outside in the morning, even a short one on a grey day, helps to set your body clock so that you feel sleepier at night. Gentle activity, such as walking, swimming or pregnancy yoga, also eases aches and takes the edge off anxiety. You do not need to do much. Little and often is enough.
3. Give your mind somewhere to put its worries
If your thoughts start racing as soon as the light goes off, try setting aside ten minutes earlier in the evening as "worry time". Write down what is on your mind and, next to each worry, one small thing you could do about it tomorrow, or simply "nothing I can do tonight". It sounds too simple to work, but many women find it helps their brain let go at bedtime.
4. Stop fighting the clock
Lying in bed willing yourself to sleep usually makes it worse. If you have been awake for what feels like a long while, get up, go somewhere dim and quiet, and do something calm and a little dull until you feel sleepy again. Keep screens away, and turn the clock so you can't see it. Slow breathing, with the out-breath longer than the in-breath, can settle a racing heart.
5. Rest when you can, without guilt
A short nap in the early afternoon is fine if it helps you get through the day. Keep it to under an hour so it does not steal from the night. If you work, it is reasonable to ask for small adjustments, such as a later start or a quiet place to sit down. Resting is not laziness. You are growing a person.
6. Tell one person how it really is
So often women say "I'm fine, just tired" when the truth is "I'm not sleeping and I'm frightened". Choose one person, your partner, a friend, your mum or your midwife, and tell them the real version. Say something like: "I'm not just tired. I'm lying awake worrying most nights and it's starting to get to me." Saying it out loud often takes some of the weight off, and it lets them help you properly. If your partner can take on some of the evening jobs, or the early mornings at weekends, that can make a real difference.
When it is time to get help
Please don't wait it out if:
- poor sleep and low mood or worry have lasted more than two weeks and are not easing
- you can't sleep even when everything is quiet and you have the chance
- you feel hopeless, numb or unable to enjoy anything
- you are frightened by thoughts that come into your head, or you are not sure what is real
- you have had serious mental health problems before and you notice the old signs coming back
Your midwife and your GP are good people to start with. They are used to these conversations and will not judge you. Being honest about how you really feel is what helps them look after you both.
And if you have tried the things above and you still feel stuck, or you would simply like to talk it through with someone who does this every day, I am here. I see women online, so you can talk to me from home. We would look together at what is happening with your sleep and your mood, what has worked for you before, and what might help now. Talking, practical changes and support from the people around you are usually where we start. Medicine is one of several things a doctor might discuss. You can read more about my antenatal appointments or book a consultation.
If you need help now
If you are in immediate danger, or you feel you might harm yourself or your baby, call 999 or go to your nearest A&E. For urgent mental health support, call NHS 111 and choose the mental health option. You can also call the Samaritans free on 116 123, at any time of the day or night.
My practice does not offer crisis or emergency care, so please use these numbers if you need help straight away.
A last word
Bad nights in pregnancy are common, and so is feeling worn down by them. You don't have to prove you can manage on your own. Look after your body where you can, be gentle with yourself about what you can't control, and if the nights are starting to take your mood with them, tell someone. Sleep and mood can both get better, and you deserve to feel well while you wait for your baby.